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Claims Resolution Rep
4 months ago
Its onsite role and candidate need to work from below office-
This position involves:
o Follows adjudication policies and procedures to ensure proper payment of claims.
o Resolves pending claims based on Medicaid rules and regulation established for final processing.
o Resolves claims resolution and/or adjustments/voids.
o Processes claim adjustments through Reversal/Replacement requests submitted by providers.
o Prices claims manually as required by Medicaid rules and system limitations as defined by policy and departmental procedures.
o Meets established production requirements consistently.
o Maintains an accuracy rate of % or better.
o Processes financial transactions.
o Review/Resolve LTC Production Reports.
o Data entry of LTC transactions.
o Monitor processing time & unfinished work on a daily basis.
o Process refund/return checks.
o Assist with monthly distribution of LTC TADS.
o Contributes a positive attitude to the team in order to meet department goals.
o Supports all departmental initiatives in improving overall efficiency.
o Assist in monitoring and timely processing of special batches
Requirements:
o Basic knowledge of Microsoft Office Outlook, Word and Excel
o General knowledge of PC
o Good working knowledge of medical claims systems
o Knowledge of CPT/HCPCS and ICD coding procedures and guidelines
o Mathematical background a plus
o Good verbal and written communication skills
o Maintain regular attendance based on agreed-upon schedule
o Maintain confidentiality and comply with Health Insurance Portability and
Accountability Act (HIPAA)
o Ability to establish and maintain positive and effective working relationships with
coworkers, clients, members, providers and customers
About USTech Solutions: US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit . US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
